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Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care

  • Guidelines/Clinical Trials/Meta-Analysis (WJ Kostis, Section Editor)
  • Published:
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Abstract

Purpose of Review

We sought to summarize recent evidence regarding optimal blood pressure (BP) treatment targets and antihypertensive regimen intensity for nursing home (NH) residents and similar older, complex patients with hypertension.

Recent Findings

Recent trials have demonstrated cardiovascular benefits from more intensive BP targets among ambulatory, less complex older adults, but generalizability to NH residents is questionable. Other trials have demonstrated that de-intensifying antihypertensives in frail, older patients is feasible, with no or modest increases in BP, but most have not assessed effects on patient-centered outcomes. Observational studies with patients more representative of NH residents suggest harms associated with more intensive BP treatment and reduction in fall risk associated with deintensification, but findings and potential for bias vary across studies.

Summary

Randomized trials and rigorous observational studies examining effects of deintensified BP management on patient-centered outcomes in complex, older populations are needed to inform improved guidelines and treatment for NH residents.

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Funding

The authors’ work on this paper was supported by the U.S. Department of Veterans Affairs (IIR 14-306, PI C. Thorpe; Office of Academic Affairs Fellowship in Medication Safety & Pharmacy Outcomes, Michelle Vu).

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Authors and Affiliations

  1. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Michelle Vu, Loren J. Schleiden & Carolyn T. Thorpe

  2. Center for Medication Safety, Veterans Affairs Pharmacy Benefits Management, Hines, IL, USA

    Michelle Vu

  3. Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA

    Loren J. Schleiden

  4. Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Kerr Hall Suite 2204, Campus Box 7573, 301 Pharmacy Lane, Chapel Hill, NC, 27599, USA

    Michelle L. Harlan & Carolyn T. Thorpe

  5. Elon University, Elon, NC, USA

    Michelle L. Harlan

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Correspondence to Carolyn T. Thorpe.

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Vu, M., Schleiden, L.J., Harlan, M.L. et al. Hypertension Management in Nursing Homes: Review of Evidence and Considerations for Care. Curr Hypertens Rep 22, 8 (2020). https://doi.org/10.1007/s11906-019-1012-1

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